1. Marilyn Rose
Abdomen Part One

2. Abdominal cavity ***Between the diaphragm and sacral promontory*****
Peritoneum
Thin serous membrane
Parietal- lines abd walls
Visceral- covers organs
The cavity houses- liver (except bare area), GB, spleen, stomach, ovaries and most intestines
Males- closed cavity
Females- communicates with exterior though fallopian tubes, UT, and vagina

3. Peritoneum contd.
Greater Sac communicates with the lesser Sac by the Foramen of Winslow (epiploic foramen)
Folds in the peritoneum= mesentery, omenta and peritoneal ligaments.
Mesentery encloses intestines and attaches them to the abd wall
Omentum- mesentery attaching to stomach
Greater- connects > curve of sto to spleen/ TRV colon
Lesser- connects duodenum, < curve to liver.

4. Ligaments 3: > omental ligaments: 2: < omental:
Gastrocolic, gastrosplenic and gastrophrenic
2: < omental:
Hepatogastric, hepatoduodenal
2: Liver ligaments:
Round (ligamentum teres)
Falciform
Diaphragm to liver:
Coronary ligaments
Margins of the “bare area”

5. Bare Area of the Liver
The coronary ligaments represent reflections of the visceral peritoneum covering the liver onto the diaphragm. As such, between the two layers of the coronary ligament there is a large triangular surface of the liver devoid of peritoneal covering; this is named the bare area of the liver, and is attached to the diaphragm by areolar tissue.

6. Peritoneal spaces Supracolic compartment Above transverse colon
R/L subphrenic spaces
Between diaph and anterior liver- R/L by falciform ligament
R/L subhepatic spaces
Post/ inferior btw liver and abdominal viscera
Rt= Morison’s Pouch– deepest in supine pt and common site for fluid collections!!

7. Peritoneal spaces Infracolic compartment Below transverse colon
R/L infracolic spaces
Divided by mesentery of small intestine
paracolic gutters
Lateral to ascentind and descending colon
Deeper RT is also a common site for fluid collections….

8. Peritoneal Spaces What is the inflammation of the
peritoneum and what is the most common cause???

9. Retroperitoneum
Structures located posterior to peritoneum and still lined by it.
Kidneys/ ureters
Adrenal glands
Pancreas
Duodenum/ ascending/descending colon AO
Inferior vena cava
Bladder
Uterus
Prostate gland

10. Retroperitoneum

11. Retroperitoneal Spaces
Anterior pararenal space
Between Grota’s fascia/ post peritoneum
Ascending/descending colon and pancreas and duodenum.
Posterior pararenal space
Posterior renal fascia and muscles of posterior abd wall (only fat and vessels in this space)
LT/RT perirenal space areas directly around kidney
This space contains the kidneys, adrenal glands, lymph nodes, blood vessels and perirenal fat

12. Abdominal Aorta

13. Abdominal Aorta Retroperitoneal
Delivers O2 blood to abdominopelvic structures
L4- bifurcates- Rt/Lt- Common iliac arteries

14. Abdominal Aorta Celiac Trunk SMA Renal arteries
Off anterior wall- 3 arteries
1. left gastric
2. common hepatic- (divides into the hepatic artery and gastroduodenal artery)
3. splenic
SMA
L1- inferior to celiac and descends behind pancreas
Renal arteries
Arise from lateral walls of AO
Below SMA
RRA longer than left and passes posterior to IVC
FYI: Renal artery stenosis can lead to HTN!!!!!

15. Normal
Abnormal

16. Inferior Vena Cava Largest vein in the body
Carries blood to the heart from the lower limbs, pelvic organs and abdomen
L5- is formed by the common iliac veins
Ascends superiorly through the retroperitoneum along the anterior verterbal column to the RT of the AO.
Renal veins- empty into L2
Lt renal vein- posterior to SMA and anterior to the aorta with the LT gonadal vein draining into it
Hepatic veins
3 – Rt/ Middle/ Lt
Collects blood from liver parenchyma
Drain from inferior liver to the superior where they empty into the IVC below the diaphragm and proximal to the Rt atrium

17. Inferior Vena Cava

18. Where is the IVC???

19. TIPS-
RA-stent

20. IVC- what is wrong?

21. IVC Thrombosis

22. If the IVC thrombosis…what then?
AZYGOUS RECANALIZATION

23. Biliary Atresia…
Leads to cirrhosis & MPV
thrombosis

24. Hepatoblastoma
How do we fix these??

25. Liver Transplant: